A woman lay screaming in agony for five-and-a-half hours as she waited for an ambulance after fracturing her leg and ankle.

Madeline Staples, a retired sales demonstrator, was a resident at the Lindan House Care Home in Percy Road, Wrexham and was described as a "fragile" patient during an inquest into her death today.

Mrs Staples, 86, suffered from osteoporosis as well as lung cancer and was also immobile.

At 10.05pm on April 6, 2018, staff responding to an alarm found her lying on the floor of her room.

According to staff member, it was obvious she had fractured her left femur and right ankle.

A 999 call was made and the inquest heard how the call was categorized as Amber 2 by ambulance control. No ambulance was available to respond and over the next few hours the situation was reviewed numerous times.

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With no ambulances available, many of them being held up in queues outside the Maelor Hospital, Ysbyty Glan Clwyd and Ysbyty Gwynedd, the West Midlands and Central and West areas were asked to help out but they, too, had no resources.

Care worker Stacy Taylor, who lay alongside Mrs Staples to comfort her, said they had made “absolutely clear” to the ambulance call taker how urgent the situation was.

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When paramedic Julie Bracchi eventually arrived at 3.40pm she immediately called for back-up to help move Mrs Staples as she considered a life-threatening situation because of the seriousness of her injuries and the amount of time she had lying there.

The second ambulance arrived at 4.34am and reached the Maelor Hospital at 5.19am.

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Mrs Staples died two days later, the cause of death given as bronchial pneumonia due to fractures.

At the inquest hearing in Ruthin today, john Gittins, the coroner for North Wales East and Central, took the decision to issue a Regulation 28 letter to prevent future deaths.

He issued the letter despite hearing what steps were being taken to reduce ambulance waiting times.

Mr Gittins told the inquest that this was the 14th such letter he or his assistants had issued in the past six years, and each time the response from the Welsh Ambulance Services Trust or Betsi Cadwaladr University Health Board was that things were going to improve.

“The danger is that we become complacent and normalize what is abnormal and unacceptable,” he said.

The coroner also read a statement by Gill Pleming, utilities manager with the ambulance service, who detailed the problems encountered on that day, with a total of 81 hours having been lost by ambulances waiting outside the three main hospitals.

North East Wales coroner John Gittins

Dr Kate Clarke, who was appointed to help improve patient care across the board, said they had already achieved some success in reducing the number of admissions to hospitals and facilitating discharges, with the result that ambulances were not having to queue for so long.

Barrister Trish Gaskell, for WAST, also outlined the measures taken by the Trust to upgrade the level of assessments by paramedics which would reduce the need for hospital admissions.

Recording a conclusion of accidental death, Mr Gittins said he could not say that the delay had played a part in Mrs Staples’ death, and he praised the work of paramedics and hospital staff in the face of huge demands.

“But I keep being told the same thing – that ‘we are doing this or that and that things will get better’,” he said.